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HOW TO CHOOSE THE RIGHT INDIAN TELERADIOLOGY PARTNER

Teleradiology is a 21st century medium of interpreting radiological images ( CT scan, MRI, XRAY, Ultrasounds) with a potential to get the best results irrespective of time or place.  India is recognized to have provided many trained personnel in the IT field, customer care, health & telemedicine across the globe .  Before april 2020 teleradiolgy in India was confined to a handful of service providers. However on March 25th, 2020   Ministry of health of India officially made teleconsultations legal .  On top of that the outbreak of the COVID-19 pandemic  led to a surge in Indian teleradiology providers in order to answer the need for huge volumes of  HRCT chests done at every level from tier 3 to tier 1 cities.     During pandemic teleradiology was embraced by many radiologists in India as it could compensate for reduced ultrasound cases without risk of getting infected .  As a result  many teleradiology service providers  have emerged in india and are functioning presently .   As a client or hospital, settle what you want first  putting your patient at the center.   Whether  you want to answer specific issues (such as night emergencies , delayed TAT etc)  or to enhance the quality of radiology services ( to improve the quality of reads and TAT)     With our experience of 12 years in this sector, we have put together handy tips that will guide you through choosing the best teleradiology service provider in India. Quality of teleradiology Service Provider Its tough to assess the impact of any diagnostic health Care Service by any sort of ratios or statistics. Referring Clinician satisfaction and client retention can be good indicators in general for assessing   the quality of a given teleradiology Service Provider. Before signing a service level agreement the client should ask for an access to prior  reports by each of the Radiologist from the given Teleradiology Services provider or sample reports and check the profoundness by reporting style. Going one step further one may ask for a trial by assigning some random cases to the provider as per your needs  . For example an Orthopaedic Hospital can assign a few trial prediagnosed MRI joints or CT scan trauma studies  with subtle tiny fractures. Or a General Hospital client can assign proven cases such as pulmonary embolism, acute appendicitis, thin subdural from the Emergency Room to test the efficiency.   Hence it is necessary to integrate into the partnership deal with the teleradiology provider, a Continuous Quality Improvement (CQI). Analysing the peer review system in the workflow as how it works, how quickly the images are routed for peer review can be important . Assessment of experience of all reporting Radiologist in the field of required modalities and subspecialities is an important factor. Indian Radiology Practise is highly modality driven  . Majority of radiologists in india practice ultrasound  but do part time teleradiology in a particular time slot or weekends . You may have a Radiologist with 10 years' experience on his CV but is only occasionally reporting gastrointestinal CT scans or MRI joints.  Large versus Small Panel Teleradiology Service Providers Size of the teleradiologists panel is important criteria for searching the right match for your organization.  Optimum size of panel to cover all 24 hours  is important at the same time stability of the teleradiologists with constant names is key to develop trust for long term relationship with the referring clinician.  Hiring a large panel of teleradiologists for a small hospital will doesn’t make sense always.  Generally large panel radiologists have a high turnover rate. Continuously changing names of the radiologists will hamper the trust building between the referring surgeon and the teleradiologists .   Besides panel size turnover rate of radiologists may indicate the stability of group. Large panel teleradiology providers in India generally comprise multiple part time radiologists who otherwise are doing  ultrasound practice at their clinics. Such groups may lack a teleradiology culture . Imagine a CT abdomen scan for suspected case of bowel perforation being read by a sonologist within his time slot provided by the telerad provider who is looking for gas under diaphragm on the scanogram.  In contrary to an experienced teleradiologists who is reporting hundreds of CT scans a day sitting for hours in his office who is trained to look for even a tiny extraluminal air.  In contrast to the large groups small but stable panels of  teleradiology service providers who are full time teleradiologists are at an advantage of  building trust and a comfortlevel with the referring clinicians due to low turnover rates.  We need to understand the difference between the optimum sized panels of stable, fulltime teleradiologists versus large panels of revolving part time radiologists. Most of the large groups employ radiologist who are  full-time ultrasonologists and reports cross section studies (CT or MRI scans) on part-time basis or weekends, so the size of the teleradiology panel is a factor in bethinking. However, the large panels have many panel radiologists needed to provide coverage which is an advantage.   Communication Of Critical Findings And Coverage In emergency cases, the consequences for the patient  can be severe if there is no  direct communication between the referring surgeon or critical care physician and the reading radiologist . Ideally, a teleradiology service provider  should have a protocol outlined for the proactive steps required to communicate the emergency findings  or unexpected findings  .  For example, the policy may be only to contact the  referring clinician on phone  in the case of a life-threatening disease or  other situations such as clinically unsuspected cases such as metastasis. Also it is equally important that the reporting radiologist him self  receives the call immediately to clarify the clinicians doubt in an emergency situation. Use of mobile SMS or whatsapp can add value. Needless to mention, a good teleradiology service provider should be covering 24/7 for 365days   Work Flow and Turnaround Time Turnaround time is the time frame between when the request of a teleradiology service provider is ordered and when the report is sent back. A good turnaround time for acute stroke should be between 10 to 30 minutes  . Teleradiology service providers must have case prioritization feature inside the PACS software .  However it is also important to give the reporting teleradiologist a comfortable environment by allowing longer Turn around time for nonemergent subspeciality focus cases. Technology and Infrastructure As far as IT infrastructure is concerned  there are three types of teleradiology service providers  in india 1. self-developed commercial IT and reading services.2. teleradiology reading service providers that have developed their own IT ( although IT not available commercially) 3. teleradiology reading service providers using third party IT solutions.  HIPAA compliance Health Insurance Portability and Accountability (HIPAA) rule that guard patient information about their health. For a standard teleradiology service provider, it is necessary to comply with HIPAA rules, which is concerned about the privacy and security of the patient information.   Teleradiology services in India are in general 20 to 40% cheaper compared to US telerad providers.    At the end, before hiring a teleradiology partner  one should be clear about the goals your organization wants to achieve  . An Indian teleradiology partner can be equally effective as a USA teleradiology provider if chosen appropriately.